Self-Employment Form
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Name
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Address
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City, State, Zip
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Phone
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Graduation Date
January
February
March
April
May
June
July
August
September
October
November
December
2001
2002
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2004
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2008
2009
I am making satisfactory progress in the pursuit of self-employment as a massage therapist, which is fulfilling my vocational and financial objectives.
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On average, I have the following number of paying appointments per month:
By submitting this information I verify that I am the above named person, and that the information provided in this form is correct.
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